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Reflectance confocal microscopy distinguishes lip melanoma from benign melanotic macules
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In vivo reflectance confocal microscopy can be used to distinguish between benign melanotic macules and lip melanoma, according to study results recently published in JAMA Dermatology.
Researchers conducted a retrospective observational study of 31 patients from two referral centers for melanoma in Australia, who were recruited between June 2007 and January 2015, and separated into two groups. Patients with clinically normal lips and different phototypes were included in the first group, while patients with benign melanotic macules and lip melanoma were included in the second group.
Lip analysis was conducted with dermoscopy and reflectance confocal microscopy.
The clinical history, dermoscopic images and histopathology in all patients with lip melanoma and five patients with benign melanotic macules were correlated with 92 in vivo reflectance confocal microscopy features.
Ten patients with normal lips (mean age, 34.5 years), 16 patients with benign melanotic macules (mean age, 49.6 years) and five patients with six cases of lip melanoma (mean age, 56.2 years) had recorded images form the vermillion and/or mucosal part of the lip.
The draped pattern, a previously described feature of lip melanoma and melanotic macules, was identified in all cases in normal lips.
Epidermal disarray, pagetoid infiltration of dendritic and/or round cells, nonspecific architectural pattern at the dermoepidermal junction, nonhomogenously distributed papillae, continuous proliferation of cells with marked atypica at the dermoepidermal junction, a higher number of dendritic cells, and atypical round cells at the dermoepidermal junction were findings in lip melanoma that were frequent and significantly different from melanotic macules.
There was 100% sensitivity and 88% specificity for diagnosis of lip melanoma of the vermillion and mucosal part of the lip, according to a created reflectance confocal microscopy lip algorithm.
Dermoscopy correctly classified as benign 81% of cases of melanotic macules, with lip melanoma classified as equivocal or malignant in 83% of cases.
“The clinical distinction between [benign melanotic macules] and [melanoma] of the lip can be challenging, and here we demonstrate that in vivo [reflectance confocal microscopy] is useful for the diagnosis,” the researchers wrote.
“In vivo [reflectance confocal microscopy] is increasingly being incorporated into the routine dermatological practice, and soon portable devices will be readily available,” the researchers concluded. “We have proposed a diagnostic [reflectance confocal microscopy] Lip Score for diagnosing pigmented lip lesions, but this will need to be validated in a larger independent study cohort.”– by Bruce Thiel
Disclosure: Uribe reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.
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